INHALED AND SWALLOWED FOREIGN BODIES 221
inserted by the patient or parent and the epiglottis may have been felt in
mistake for the object. The probing finger may scratch the mucosa of the
pharynx or hypopharynx. On indirect laryngoscopy in the adult excessive
secretion lying in the pyriform fossa is highly suggestive of a foreign body
lodged in the oesophagus. In some cases the object may be seen.
Fig. 111. Coin arrested at upper end of the oesophagus. (Note the position of the coin in relation to the
mandible and the clavicles.)
Radiography is advisable for all opaque foreign bodies (Fig. 112) and
anteroposterior and lateral views should be obtained to determine the level
and position of the object. If the foreign body is non-opaque it rs debatable
whether a thin barium swallow should be given before radiography. This may
outline the object, which is thus demonstrated, but at subsequent oesophago-
scopy the barium must be aspirated so that the foreign body may be inspected
and removed, and later in order that the oesophageal walls may be thoroughly
examined for any tear.
TREATMENT. When the presence of a foreign body in the oesophagus has
been demonstrated radiographically it must be removed. If the symptoms of
pain or obvious blockage lead to a diagnosis of foreign body, oesophagoscopy
must be performed. If there is a history of something having been swallowed,
and having stuck, but when there are no remaining symptoms, and the
object is not opaque to radiographs, the decision to examine by oesophago-
scopy must be considered. A negative oesophagoscopy removes all doubt. A
positive oesophagoscopy also removes all doubt. If oesophagoscopy is not
performed, doubt remains, and there is always the possibility that an object
left in the oesophagus may ulcerate or perforate the walls. Oesophagoscopy
under general anaesthesia causes little discomfort afterwards and it is wiser
to recommend it on all occasions.
Oesophagoscopy is best performed under general intubation anaesthesia.
It may be a prolonged procedure; the presence of an oesophagoscope may